AB0781 Malaysia Spondylarthritis Accelerated Management (SAM) Model: Expediting AxSpA patient journey from early referral, diagnosis and access to optimal care
Authors: F. Yahya, H. Mohd Yusoof, A. Mohd, S. Ch’ng Suyin, S. C. Gun, M. Mohd Zain, S. Sockalingam, S. L. Lai, C. Bao Jing, J. Tiong, I. S. Lau, R. Sengupta
Journal: Annals of the Rheumatic Diseases (2022)

Background Axial spondyloarthritis (axSpA) is an important cause of inflammatory back pain (IBP). It is under-recognized, leading to significant delays in diagnosis. Early recognition and diagnosis are crucial to achieve the best outcomes for patients and in Malaysia, significant gaps in the clinical management of axSpA remain. Therefore, we sought to implement a strategy to improve the time to diagnosis and management of axSpA in Malaysia by collaborating and adopting guidance from an international axSpA expert. Objectives The objectives were to improve disease recognition among healthcare practitioners (HCPs), reducing time to specialist referral and diagnosis whilst improving disease management by developing and implementing a new patient care model called the Spondyloarthritis Accelerated Management (SAM) and measure its effectiveness in 3 Rheumatology centers in Malaysia. Methods The SAM initiative was developed by the Malaysian SpA Consortium Working Group involving 8 Malaysian rheumatologists from 3 local centers and 1 international axSpA expert from the UK as part of the steering committee. Selections were based on clinical expertise. The first local alignment meeting on model structure was held in July 2020 with subsequent meetings held to address key barriers to early axSpA diagnosis and timely access to quality care. A care model with feasible key performance indicators (KPIs) was established, adapted and tracked monthly in the 3 rheumatology centers (Figure 1). Referral tools were developed to facilitate early referrals to rheumatologists. These included a QR-coded ‘3-R’ referral guide 1 and a patient self-screening tool with a patient self-referral letter all hosted on the Malaysian Society of Rheumatology (MSR) website, educational talks to HCPs and public awareness forums on IBP and axSpA. Data were collected on referral source, duration of referrals, knowledge on IBP in HCPs by surveys and imaging accessibility at baseline and at 1 year after the initiative was launched. Baseline data collected were from August to October 2020 and 1 year data were from November 2020 to November 2021. Figure 1. Summary of optimal Key performance indicators (KPIs) for Malaysia SAM Results At 1 year, the SAM initiative showed a 44.4% (Median: 1.33 [IQR 1-1.7] vs 1.92 [IQR 1.6-2.1]) increase in IBP referrals, a reducing trend from 9.5 (IQR 8-11.1) to 5.9 (IQR 5.1-6.8) weeks of waiting time to a first Rheumatology visit and an increase of 37.2% (34% vs 71%) in IBP patients who were seen at the rheumatology clinic within 6 weeks. All patients with IBP had x-rays (sacroiliac joints or pelvis). MRI requests in x-ray negative patients suspected of axSpA was increased by 13.9% (77.8% vs 91.7%) and waiting time for MRI was reduced by 3.1 weeks (12 vs 8.9 weeks). The IBP knowledge among 224 HCPs improved by 40.6% (45.7% vs 86.3%). The number of patients newly diagnosed with axSpA increased by 40% (Median: 5 [IQR 4-9.5] vs 7 [IQR 6.5-7]) despite the COVID-19 pandemic. Conclusion The SAM initiative has shown promising initial results in improving referrals of patients with IBP, promoting earlier diagnosis and establishing the importance of having timely access to optimal care. A nationwide implementation is being planned to improve the recognition of the axSpA in Malaysia. References [1]Lau, Ing Soo et al., Malaysian family physician, vol. 16,2 2-6. 27 May. 2021 Acknowledgements Authors would like to acknowledge that this abstract is part of the Malaysia SpA Consortium Working Group. The SAM expert panel discussion and the preparation of this abstract were funded by Novartis (Malaysia). The authors acknowledge writing support from Vidya Sagar AEC (Novartis, Hyderabad) Disclosure of Interests Fariz Yahya Speakers bureau: Novartis, Eli Lilly, ZP Therapeutics, Pfizer, Janssen, Gilead, Abbvie, Upjohn, Paid instructor for: Novartis, ZP Therapeutics, Abbvie, Consultant of: Novartis, Eli Lilly, ZP Therapeutics, Pfizer, Gilead, Abbvie, Janssen, Grant/research support from: Gilead, Galapagos, Abbvie, Janssen, Novartis, Habibah Mohd Yusoof: None declared, Asmah Mohd: None declared, Shereen Ch’ng Suyin Speakers bureau: Pfizer, Boehringer Ingelheim, Johnson &amp; Johnson, Novartis, Abbvie, Suk Chyn Gun: None declared, Mollyza Mohd Zain: None declared, Sargunan Sockalingam Speakers bureau: Novartis, Roche, Johnson &amp; Johnson, Pfizer, Paid instructor for: Johnson &amp; Johnson, Grant/research support from: Novartis, Siew Li Lai Employee of: Novartis, Chen Bao Jing Employee of: Novartis, John Tiong Employee of: Novartis, Ing Soo Lau: None declared, Raj Sengupta Speakers bureau: Abbvie, Biogen, Celgene, Lilly, Novartis, Roche, UCB, Consultant of: Advisory boards for Abbvie, Biogen, Lilly, Novartis, UCB, Grant/research support from: Abbvie, Celgene, Novartis, UCB